March 2013: Z. Harcombe, J. Baker, B. Davies. “Food for Thought: Have We Been Giving the Wrong Dietary Advice?” Food and Nutrition Sciences 2013; 4(3): 240-4. (This is the second most popular paper for the journal Food & Nutrition Sciences, confirming the interest in progressive, rather than conventional, thinking.)

And, of course, none of these should have been necessary as Uffe Ravnskov ended the debate in May 2010 in this book – viewable here.

Many thanks for this Matthew – I hadn’t seen this one. I’m not sure it’s a challenge to current guidelines however: “These findings do not support a need for major emphasis in dietary guidelines on either increasing or decreasing butter consumption, in comparison to other better established dietary priorities…”
Best wishes – Zoe

Hi Zoe,
Did you address somewhere Susanne Holts paper Am J Clin Nutr 1997? As a LDL-R negative FH (C146X exon 4 mutation), I am interested in your opinion on the discrepancies between glycaemic- and insuline-responses. From inflammatory burden perspective this might be relevant, as we want to prevent relatively high insulin levels. My ancestors did not have vascular disease, lived longer than historic controls, members of the Sijbrands BMJ cohort. I am the only one with DM and the only one with a history of 40 years of statin use (not counting).
Best regards
Arthur

Hi Arthur
Funnily enough – that paper came up in an email forum today. I’ve not reviewed it. The only surprising thing (probably) would have been the insulin and to a lesser extent glycaemic response to protein.

Two of the comments that were made in the chat were:

1) “An explanation for the glycemic response to protein in some people is that amino acids also elicit a strong glucagon response. That’s nature’s way of preventing hypoglycemia on a low carbohydrate diet (counterbalancing the insulinotropic effects of amino acids).

The insulinemic index doesn’t take into account the important biological differences between high insulin/suppressed glucagon (after high glycemic index carbohydrate) vs high insulin/high glucagon (after some animal products). The former is highly anabolic to adipose tissue; the latter isn’t.”
and
2) “Glucogenic amino acids from the protein are then converted to glucose via transamination/deamination ultimately to pyruvate and then back towards glucose via gluconeogenesis. All mediated under glucagon’s phosphorylation inhibiting glycolytic and activating gluconeogenic enzymes in liver.

However, I’ve never read previously that this would elicit an insulin response comparable to sugar intake. It is true that extra protein carbons end up as fat. But as soon as glucose goes up, the glucagon decreases and the insulin elevates slightly to return to normal levels.”

Thanks Zoe,
very interesting; ad 1: glucagon falls rapidly, which may add to the lesser postprandrial glycemic effect.
About your FH-post: indeed, nowhere did I find ARR / NNTs or convincing natural risks for FH with / without treatment. If equal lipid levels in FH vs non-FH are associated with different risks, you want to know why, and you certainly do not feel reassured with a therapy that raises HOMA-IR 30% even without overt DM. Clearly defining uncertainties in papers is a matter of public health.

Hi Zoe! Where can I find the “checklist” you mentioned regarding establishing likelihood of causality vs. association. It is such a good list and I’ve not been able to find it. Items like plausible mechanism and minimum of 3X (or 10X?) association. Perhaps that would be a good reference in your website “research” header.

Hi Rob
It’s known as “The Bradford Hill Criteria” – original paper here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1898525/
Start with “strength” and if this isn’t in the order of double or more (chimney sweeps and scrotal cancer was 200 fold!) – then look no further!
Best wishes – Zoe

Hi Zoe,
Thanks for pointing out all the facts that do indeed show a pound of fat is equal to approximately 3,500 calories. Whether it is precisely 2,843 or 3,555 calories per pound of fat is another matter, but it would be around 3000 to 3500. Showing why it hard to lose weight with diet alone, and that exercise or burning more calories is a must.

Not sure why you are calculating someone taking in an extra 657 calories a day (or roughly 13 of those 50 calorie biscuits, for an extra 4,745 biscuits during the year) each an every day for 365 days. (The difference between 3500 and 2843 as you are using it here has as much to do with the weight a person might gain or lose as the price of tea in China does.) But yes, if someone ate an extra 13 biscuits each and every day for a year on top of their regular diet, one could see them gaining an extra 84 pounds in a year. Of course as they started gaining the extra eight they would burn more calories each day, but they would still be looking at a big weight gain.

Now if they only have one extra or one less biscuit per day, then they would take in an extra 18,250 calories or less 18,250 calories over the year (365 x 50 = 18,250), which if 3,500 calories per pound is used would amount to a gain or loss of 5.2 pounds. If it is 2,843 per pound it would be a little more (6.4 lb), but 3,500 calories per pound appears to be a good approximation.

Think you need to look at the equations for calories burned, be it at rest or if moving. If typical calories used each day for woman are 2,000 and men are 2,600, that would end up largely reflecting their difference in weights. A man weighs substantially more, and would burn more calories at rest or when active and moving around. As would any person consuming an extra 657 calories per day, they will end up weighing substantially more, and then end burning more calories at rest or when active each day.

Hello Zoe, I have just watched your youtube lecture at the Cardiff University. I am an Osteopath specialising in paediatric care. I see lots of conflicting advice about low carb high fat diets for breastfeeding mothers (the general consensus being that they need carbs for the energy) this doesn’t fit with your stated fact that we don’t need carbohydrates to survive. I want to give my patients sound, practical advice and would like to know if you have come across any research related to saturated fat intake and breastfeeding, the few that I have seen are not favourable.

I think every human being – young/old/male/female/breastfeeding or not – should eat real food. We should eat for micronutrients and then the macrnonutrients will be what they will be.

This is my view and information, not advice – I heard a radio prog last week about doctor insurance being several thousand pounds a year. I don’t envy those of you who give advice – especially when the official advice (safest to follow to not be sued) is so bad!
Best wishes – Zoe

Two years ago I discovered your books, they helped me lose weight when I had a knee replacement. I am now 80 and have slipped with the diet.
Now they tell me I have glucose in my blood and I yesterday saw a dietician. She has given me a booklet dated Aug 2010, reviewed Aug 2013! Which advocates 3 meals daily based on starchy foods!
I eat Gluten free bread etc, a personal choice, ( I wasn’t asked why) I have limited it to two slices a day.
I eat a lot of eggs and was told to only have 4 a week ( I put three in an omelette!) as they are high is cholesterol. When I queried this, my question was ignored and the speil was continued without pause.
I was not invited to offer reasons for my choice of diet, it was more of a dictat than a consultation, and I felt very frustrated. The out come of the ‘interview’ was an injunction to return in 3 months to be weighed ‘again’, I wasn’t weighed at this point!!
Money for old rope I decided – I could have taken the consultation myself, and filled in the noted cards.
I am left in more confusion and will continue with your dietary suggestions, that worked for me before and ‘yah sucks boo!’ to any dieticians who are just there for the money and not for the patient’s welfare.
Thankyou Zoe for being our watchdog.

Hi Frances
I wish people would start suing the people who issue such advice – healthy will be harmed sufficiently to interest no win no fee lawyers!
This is quite dreadful
Keep reading/watching intelligent stuff – you may like this genius (and I don’t use that word often) https://www.youtube.com/user/drjasonfung

Hi Zoe, I have really enjoyed reading more about you after first discovering you on Dr Mercola. So much of what you are teaching makes perfect sense.
I am a recent convert to eating more saturated fats having discovered the works of Dave Asprey – he of Bulletproof Coffee fame. I have actually signed up for his new coaching qualification and am looking forward to helping others. I’m also a complete convert to intermittent fasting and have found four of my six pack in the last few weeks, after many years of them being neatly concealed!

I don’t think you’ve appeared on Bulletproof radio yet, Dave’s podcast, but you’d be excellent and you are both definitely on the same page when it comes to dietary advice. He also runs a conference in LA which I am attending later this month.

Anyway, I just wanted to say how much I really enjoyed listening to your talk and to wish you every success with your continued education of a misled population.

Zoe, In your video, you say that the body will not use any Carbs for the kcal needed for the energy required for its BMR; they will only come from protein and fat. Can you point me at some links to allow me to do some background reading on this pls.
Thanks, Andy.

This shows that any macro nutrient can provide energy (protein will be the body’s last choice), but only fats/protein/vits and minerals do ‘the body work’.

Strictly speaking I should have made up a term called “Body Maintenance Only”, not Basal Metabolic Needs, as some energy is still needed if we’re lying ill in bed all day. Think of calorie requirement in two parts – that needed for body work and that needed for energy – and call the two parts whatever works for you. Wiki is as good as anywhere for the Harris Benedict equations (http://en.wikipedia.org/wiki/Harris%E2%80%93Benedict_equation) to define BMR and then stuff needed over and above.

I’m open to being wrong – it would require evidence that carbs do the body work – not just provide energy. Carbs do provide vits and minerals – and these are vital for body work – but the carb itself is useless.
Hope this helps
Best wishes – Zoe

Hi Andy
I don’t advise macro nutrient targets. I just advise people to eat real food and choose the food for the nutrients it provides (http://www.zoeharcombe.com/2014/04/healthy-whole-grains-really/) and meat/fish/eggs/veg will naturally be chosen instead of whole grains/fruit etc. This will tend someone to higher fat/protein intakes and lower carb but I don’t set targets for any of these. I want to liberate people from counting if at all possible and I don’t know that there is a perfect macro nutrient mix – we’re all different and differently active/carb sensitive etc.

The LCHF recommendations can be worked out with this site http://www.homodiet.co.za/
A very well informed LCHF devotee in Norway shared that one with me!
Hope it helps
Best wishes – Zoe

Would it be to simplistic for me to assume the kcal from carbs I need daily are = Y+Z, given below?
BMR = X kcal
+ Y kcal (eg. energy for sedentary desk job lifestyle)
+ Z kcal (any energy used via exercise)

If my preferred way of managing my weight was to track/log what I eat/exercise and I could closely approx. my kcal from carb consumption/energy expended on exercise and therefore could keep a tally of the amount of kcal from carbs I need and thus eat, would that be an unhealthy thing from both a weigh loss and/or weight maintenance point of view?

3) It’s still not about calories! Read my obesity book if you think it is or Gary Taubes Good calories Bad calories or the many other books/web sites out there that don’t buy the calorie theory. All (1) and (2) tell you is your fuel requirement in the currency that we measure fuel for the body, which is calories. The huge mistake we made is that made up conversion between weight and calories (the 3,500 nonsense). Energy is energy, weight is weight – they are so very different!

4) You can track all of this, but, given (3) why would you want to and why would you want to anyway? Life is too short! Just eat real food, max 3 times a day and manage carb intake if you need to lose weight. If I had to think of 10,000 fun things to do, counting calories wouldn’t be on the list! 100,000!

Hi Zoe, Just reading your web page with interest. I have FH alongwith my mother age 60 and two children. My latest cholesterol level just came back at total 9.6, and have been prescribed a statin. Interested on your views for treatment on FH… Thank you

Hi Zoe,my name is Jeraldine Curran I have a BSc Nutritional therapy and currently studying for an MSc Nutritional Medicine at Surrey.
Would really love to talk to you regarding the information that we are being taught. It is focused around the eatwell plate, need I say more, currently in talks with the professor that put the eatwell plate together who still lectures on the course. really pleased with your research. Please email if you are willing to discuss this further. We really need dietary advice to change.

http://www.sciencedaily.com/releases/2014/11/141121151104.htm
Doubling saturated fat in diet does not increase saturated fat in blood
I also like this one:http://www.nature.com/ijo/journal/vaop/naam/abs/ijo2014199a.html
Energy balance measurement: when something is not better than nothing
Abstract:
Energy intake (EI) and physical activity energy expenditure (PAEE) are key modifiable determinants of energy balance, traditionally assessed by self-report despite its repeated demonstration of considerable inaccuracies. We argue here that it is time to move from the common view that self-reports of EI and PAEE are imperfect, but nevertheless deserving of use, to a view commensurate with the evidence that self-reports of EI and PAEE are so poor that they are wholly unacceptable for scientific research on EI and PAEE. While new strategies for objectively determining energy balance are in their infancy, it is unacceptable to use decidedly inaccurate instruments, which may misguide health care policies, future research, and clinical judgment. The scientific and medical communities should discontinue reliance on self-reported EI and PAEE. Researchers and sponsors should develop objective measures of energy balance.

Hi Gaby – thanks so much for these. The doubling sat fat one is in there already – the 21st Nov 2014 PLOSOne Volk et al. I’ve added in the Lamarche one – I had it in my EndNotes, so I should have spotted that – nice one! I’ve credited you :-)
Well done with your own health progress – may it long continue
Best wishes – Zoe

Thanks very much for this list. I did notice, however, that the first and latest paper on your list, “How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative.” is a little troubling in that it promotes animal products, added oils and fats. They only focus on the hunger cycle and its impact on obesity with little regard for CHD, Cancer, dementia etc associated with animal protein and added fat.

Those conditions you name, as far as the last 5 years of reading medical articles and opinion is concerned, are results of excess carbohydrate consumption.

The last 50 years advice of eating 60% grains has been the disaster. Search for the hyperlipid blog for numerous articles from a heavy sat fat & low carb eater- based on evidence.

Personally, as a result of high fat/ low carb, my serum triglyceride level has plummeted and HDL has significantly increased. Doctor congratulated me for eating ‘plenty of grains and fruit and veg’ to get these numbers. Didn’t argue, as it would not compute with her.

I came upon your ‘diet’ whilst looking up calorie counting, downloaded your book and now two weeks later and seven pounds lighter! I hesitate to call it a diet because I have not been hungry once. No more trying and failing to work out calories. No more food diaries. No more borrowing calories from the next day and then not managing to eat less.I just follow the rules-don’t mix carbs with fats and don’t eat processed food. I also walk or swim for half an hour each day. Food tastes so good and it is not more expensive to eat this way. I sat down tonight to baked salmon with lemon juice, fresh green beans and sprouts, stewed berries and apples and full fat plain yoghourt. Oh, and one small glass of chilled white wine. I was just naturally hungry and ready to eat and it tasted so good. The natural sweetness of the fruit was lovely. I still find eating full fat a bit scary but you find you don’t need so much and it fills you up. Bags of energy and skin nice. Only got half a stone to go and will carry on as I am as I want this weight off. However this is a way of eating that makes a bigger weight loss over a longer period much easier. My diet before was good but the weight loss has come from cutting my carbs right back, eating unprocessed carbs and giving up low calorie stuff because that too has too much sugar. The food industry has a lot to answer for. Processed food makes you fat. Snacking between meals makes dieting slower and harder.Thank you. Best book I ever bought.

More on the subject – I found this infographic explaining the difference between “good” carbs and “bad” carbs and how bad carbs impact people with diabetes. It’s based on a study done by Harvard School of Public Health: http://www.lowcarbfoods.org/good-carbs-vs-bad-carbs.php

Bill- yes, thanks, I have read much on the subject- (it’s very interesting!) I hadn’t included a link before because I couldn’t find an actual scientific study where current dietary advice was questioned by the researches; (for instance, although Dr. Seyfried recommends a ketogenic diet for treating cancer, he doesn’t seem to believe that our modern diet causes it in the first place). But, just for kicks, I’ll post this link (just one of very many articles about the ketogenic diet for cancer treatment): http://www.examiner.com/article/ketogenic-diet-starves-cancer-cells-says-researcher-dr-dominic-d-agostino-1

Excerpt from Abstract:
Higher intakes of whole fat milk, yogurt, and cheese were associated with better cardiovascular health. Even when controlling for demographic and dietary variables, those who consumed at least 5 servings per week of these dairy products had a significantly higher CHS than those who consumed these products less frequently. Higher total whole fat dairy food intake was also associated with other positive health behaviors, including being a nonsmoker, consuming the suggested dietary intakes of recommended foods, and having a normal body mass index. Increased dairy food consumption was associated with better cardiovascular health.

One has to be very very careful with nutritional studies. I’d like to see the whole article. What may be left out is what the low-dairy group may be eating instead. Are they replacing milk-fat with junk food or animal fat? I wouldn’t be surprised if this is not controlled for in the study. Of course I don’t see any mention of CVD, cancer, diabetes, dementia impacts in the abstract.

I love your site Zoe and the various paths it takes me. However you asked for more papers etc.
You probably know these guys Zoe, Peter Attia certainly knows about you because I saw he referenced you in one of his blogs. However, I got to him via his TED talk below. He is a surgeon and has a blog site “The Eating Academy”

That led to me to Chris Masterjohn and his paper “Does dietary choline contribute to heart disease” This is an article (10th April 2013) on the “The Western A Price foundation” (no adverts). I notice that he acknowledges other people I recognise such as Steven Guyanet.

Thanks for these links, they’re a great resource. I have dramatically changed the way I work with clients partly down to your blog and discovering just how much healthier low carb is. It’s all about the real food and the links above are great for people who aren’t convinced so thankyou very much!

Hi Zoe- I’m interested in cancer research, and there have also been studies recently showing a possible correlation between high carbohydrate diets and various forms of cancer. There was one study about breast cancer survivors- (I’m sorry, I don’t remember the year)- where the result was that women who ate a lower carbohydrate diet had less recurrence and death than those on a high carbohydrate diet. The authors of the study questioned the dietary advice given to women with breast cancer- (which is the usual “eat lots of fruits and vegetables and whole grains, limit meat and saturated fat” nonsense). And just recently, there was a study done at Toronto University (I believe), where mice fed a high carbohydrate diet had more colon cancer than mice eating a low carbohydrate diet. OK, so that was just mice, but there is an earlier human study (20012 I believe) finding again, that colon cancer survivors eating a low carbohydrate diet had better survival and less relapse than those on a high carbohydrate diet. (Sorry for not posting the links: I can’t seem to be able to post links on your website). Anyway, I thought these studies were particularly interesting because for years we’ve been told that colon cancer is caused by eating red meat and too little fiber.

Hi Lisa – there isn’t an ‘insert link’ function, but you can just put complete URLs in – as Ash did. If there are more than a couple it may end up in spam so you could post 2 comments – one asking me to check spam for the other!

Please do try if you have the links – others will appreciate them.
Many thanks
Best wishes – Zoe

I haven’t been able to find the particular study on breast cancer that I mentioned- (I read it about 1 year ago; I was writing about it from memory). I’ll keep looking though; or maybe I’ll post something else eventually.

I find it interesting that Dr. Warburg’s theory was “debunked” awhile back, but now it’s making a (much needed) comeback. A lot of this nutritional information has actually been known about for quite awhile; we just unfortunately went down the wrong path, partly due to the flawed diet-heart-hypothesis (among other reasons).

These conclusions are so counter to what research is showing – why bother to look up some elusive study when there are dozens showing the direct correlation between high fiber, vegetables, high unrefined carbs to low breast cancer rates and increased survival?

Because those are correlations and don’t prove causation? Look up the Women’s Health Initiative trial, an actual randomized, controlled trial, which unlike epidemiological studies can actually prove causation. This was a massive trial that split women into two groups, one of which was actively counseled to decrease fat and saturated fat and to increase fruits and vegetable. It cost upwards of 420 MILLION US dollars. It was THE study to end all studies and prove that a low fat and increased vegetable diet was better than a “normal” diet. The results? A failure.

“CONCLUSIONS:

Over a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors, suggesting that more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk.”